The increasing prevalence of type 2 diabetes worldwide emphasizes the importance of understanding its different risk factors. Attention is currently being directed to dietary carbohydrates, a major source of dietary energy, as a risk factor for type 2 diabetes. The quality of carbohydrates has been suggested to be crucial; carbohydrates that induce a rapid elevation in blood glucose have detrimental metabolic effects compared with carbohydrates that elevate blood glucose more slowly and steadily. Eating a low glycemic index (GI) diet can be a great way to maintain stable blood sugar levels, manage your weight, and improve your overall health. If you're following a low GI diet, it’s important to think about how alcohol fits into your routine.
Understanding the Glycemic Index
The glycemic index (GI) measures the ability of a food to raise blood sugar levels. A measure that ranks foods on the basis of the blood glucose response that they produce upon ingestion (compared with the response of a reference glucose solution or white wheat bread) is the glycaemic index (GI). Foods with a low GI (below 55) are digested more slowly, causing a gradual and moderate increase in blood sugar. Alcoholic drinks, for their part, have varied GIs depending on their sugar composition. For example, beer explodes the scores with a GI of 110, even more than glucose which is the reference at 100!
The Impact of Alcohol on Blood Sugar and Insulin Sensitivity
One of the major concerns regarding alcohol consumption is its effect on insulin resistance. Insulin resistance happens when your body's cells don’t respond to insulin as well as they should, making it harder for you to process glucose (sugar) in the blood. Over time, this can lead to higher blood sugar levels and increase the risk of developing type 2 diabetes. Research shows that heavy or long-term drinking can contribute to insulin resistance, especially when it’s combined with an unhealthy diet or sedentary lifestyle. Excessive alcohol consumption can lead to fat buildup in the liver, a condition known as non-alcoholic fatty liver disease, which makes insulin resistance even worse.
Having good insulin sensitivity is vital for maintaining healthy blood sugar levels. When insulin sensitivity is high, the body needs less insulin to process glucose effectively. Unfortunately, poor insulin sensitivity can lead to higher blood sugar levels, which over time can contribute to diabetes. Some research suggests that moderate alcohol consumption, particularly red wine, could enhance insulin sensitivity. This is believed to be due to antioxidants in wine, like resveratrol, which might help regulate blood sugar levels. However, it’s important to note that while alcohol may improve insulin sensitivity for some people, it’s not always the case. For instance, drinking on an empty stomach or binge drinking can reduce insulin sensitivity and lead to erratic blood sugar levels.
Alcohol itself doesn’t cause insulin spikes in the same way sugary foods or drinks do. However, alcohol does affect the body’s ability to regulate blood sugar in indirect ways. When you drink alcohol, your liver works to break it down, and in the process, it prioritizes alcohol metabolism over other functions, such as regulating blood sugar. This can sometimes lead to a temporary drop in blood sugar levels, particularly if you drink on an empty stomach. In response, the body may release glucagon, a hormone that raises blood sugar levels. This could lead to a spike in blood sugar after the initial drop, which might be confusing, especially for people with diabetes.
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Choosing the Right Alcoholic Beverages
Some alcoholic drinks, like dry wines and spirits such as vodka, have a low glycemic index and may be suitable for those watching their blood sugar levels. But other drinks, such as beers and sugary cocktails, tend to have a higher GI and can cause rapid spikes in blood sugar.
When it comes to alcohol, the glycemic index of alcohol varies quite a bit, depending on the type of drink. Alcoholic beverages that are sweetened or made with sugary mixers generally have a higher GI. On the other hand, drinks like wine and spirits such as vodka tend to have a lower glycemic index.
Here's a closer look at some popular alcoholic beverages and their potential impact on blood sugar:
Beer
Beer glycemic index can differ based on the type and brand of beer you choose. Generally speaking, beer tends to have a moderate glycemic index, usually somewhere between 50 and 110. Lighter beers often have a lower GI, while darker beers tend to have a higher GI. This difference is due to the carbohydrate content in beer, particularly the presence of maltose, a sugar that can raise blood sugar levels.
Light beers contain fewer carbohydrates than regular beers. For many brands, a light version of beer can contain around half the carbs of a regular version. In general, beers tend to be lower in sugar than other alcoholic drinks. It’s their carb content, however, that has the biggest impact on your glucose. The carbs come from grains like barley and wheat, which brewers ferment to make the beer, as well as sugar, which brewers may add to speed up fermentation. Having fewer carbs means that drinking a light beer will result in a smaller rise in glucose than drinking a regular beer would.
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Here are some popular low carb beer options:
- Miller Lite: An American-style light lager with 3.2 grams of carbohydrates per 12-oz serving.
- Coors Light: Another American-style light lager, providing 5 g of carbs per 12-oz bottle.
- Bud Light: A low carb beer with 4.6 g of carbs per 12-oz serving.
- Busch: Regular Busch contains just 7 g of carbs per 12-oz serving, while Busch Ice and Busch Light provide 4.2 and 3.2 g, respectively.
It’s worth noting that non-alcoholic beers can contain considerably more carbs than their alcoholic versions. So, while they’ll stop you getting tipsy, they may be more likely to get your glucose levels rising. Be sure to check the labels if you’re going down this route.
Wine
Next up is wine glycemic index. Depending on whether it’s red or white and whether it’s dry or sweet, wine can fall into different ranges on the glycemic index. Dry wines, both red and white, tend to have a lower GI, which makes them a better choice for people concerned about their blood sugar levels. Generally, the GI of wine falls between 30 and 50, which is relatively low compared to many other alcoholic beverages. If you’re a red wine drinker, you’re in luck. The red wine GI is often on the lower end of that scale, and some research suggests that red wine may even help improve insulin sensitivity thanks to its polyphenol content.
When it comes to wine, your best bet for steady glucose will be to choose a dry wine. Dry wines contain little residual sugar, with the pre-existing sugar fermenting into alcohol during the winemaking process. In contrast, sweet wines (perhaps unsurprisingly) contain a certain amount of residual sugar, giving them their flavor.
Some examples of dry wines include:
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- Brut Champagne
- Prosecco
- Cabernet sauvignon
- Malbec
- Merlot
- Pinot noir
- Pinot grigio
- Sauvignon blanc
- Chardonnay
As an example, a serving of merlot red wine contains around 1 gram (g) of sugar, and a serving of chardonnay white wine contains about 1.5g. In contrast, a serving of rose wine contains about 5.5 g.
If you’re considering an alcohol-free wine, it’s worth noting that many bottles contain added sugar to balance the flavor in the absence of the alcohol. If you’re shopping for alcohol-removed wine, make sure to check the nutrition label and ingredients for added sugar.
Here are two types of wine with low carb counts:
- Red wine: A 2023 review of studies indicates that red wine can provide health benefits for people with diabetes, such as decreased oxidative stress, inflammation, and cardiovascular disease risk. A standard 5-oz serving provides only 3.8 g of carbs.
- White wine: The carb content in white wines is comparable to red wines, with 3.8 g of carbs in a standard 5-oz glass. Dry and Brut champagne varieties are also low in sugar.
Liquor
On their own, many types of liquor contain zero carbs or sugar due to the distilling process. This lack of sugar and carbs means that - on its own - liquor is unlikely to cause a glucose spike.
Examples include:
- Vodka
- Gin
- Whisky
- Tequila
- Rum
Unlike beer and wine, vodka doesn’t contain many carbohydrates, so it has a very low glycemic index-essentially 0. This means that vodka doesn’t cause a spike in blood sugar levels directly. Tequila is made from the blue agave plant, and like vodka, it is typically free from carbohydrates, which means it has a glycemic index of 0.
These liquors contain 0 g of carbs per 1.5-oz serving. However, the carb content of your drink may vary depending on what you mix the liquor with. Try to avoid mixing liquor with sugary juices or sugar-containing soda. If you do drink these with alcohol, your blood sugar may spike and then dip to dangerously low levels.
Shots don’t lend themselves to casual drinks, however, and so it’s the mixers that you’ll need to think about when it comes to keeping steady. Many classic mixers, such as fruit juice and soft drinks, will introduce a lot of sugar to your beverage, making it far more likely to spike your glucose. Instead, try a shot of one of these types of liquor in a glass of plain sparkling water. You can add extra flavor and sweetness with some slices of fresh fruit or sprigs of rosemary or thyme.
Hard Seltzers
Hard seltzers are a combination of seltzer water, alcohol, and usually some kind of flavoring. These drinks are generally low in both sugar and carbs, meaning they’ll have less of an impact on your glucose than many other drinks. In comparison with light beers, they’re lower in carbs, but some may contain a small amount of added sugar. They’re also lower in carbs than dry wines, and their sugar content can be similar depending on the type.
Different brands of hard seltzer contain different amounts of sugar, but in general they’re a good bet if you’re looking to keep your glucose as steady as you can while drinking.
Cocktails to Avoid
On the other side of the coin, there are plenty of alcoholic drinks that can cause your glucose to rise rapidly. If you’re looking to limit the sugar in your drinks, you may want to steer clear of these:
- Cocktails with sugary ingredients, such as Long Island iced teas and piña coladas.
- Liquor that comes with sugary mixers, such as fruit juice and soft drinks.
- Dessert wines, such as sherry, port, and ice wine.
- Liqueurs, such as coffee liqueur, crème de menthe, and advocaat.
The drinks listed above contain a lot of sugar. But there are also some with higher carb counts that aren’t necessarily sugary but can have a similar effect. Darker beers (think certain ales, stouts, and porters) use more grains in their brewing, giving them a higher carb count. So, you may want to limit these drinks if you’re aiming to keep your glucose steady.
Dessert wines, such as vermouth, port, and sherry, are also high in carbs. As the name of these drinks implies, people typically serve them after a meal. The same goes for cream liqueurs such as Bailey’s Irish Cream and Kahlua. These provide around 13 g of carbs, of which 12 g are from sugar, for every 2 oz of liqueur.
Low-Carb Cocktail Options
Try to opt for low sugar options if you feel like having a cocktail. Here are some low carb cocktails:
- Martini: Made by mixing gin or vodka with dry vermouth in a 2-to-1 ratio, a martini contains only 0.2 g of total carbs in a 4-oz drink.
- Vodka soda: Combining vodka and club soda results in a drink with 0 g of carbs.
- Bloody Mary: Mixing vodka and tomato juice with various sauces and spices, a Bloody Mary has a carb count of 7 g.
Additional Tips for Steady Glucose Levels
Keeping your glucose steady isn’t just a matter of the drinks you choose. How you drink them and what you do before and after has an impact too.
Here are some other tips if you choose to drink alcohol during a social event:
- Don’t drink on an empty stomach. Grab something to eat beforehand to reduce the impact of alcohol on your glucose. We recommended eating something with protein, healthy fats, and fiber to keep your glucose steady before drinking.
- Go for a walk after drinking. Physical activity after eating or drinking can lessen its impact on your glucose.
- Drink some water and eat some unsalted nuts alongside your alcoholic drinks. The water will keep you hydrated, and the fat and protein in the nuts can make it easier for your body to stabilize your glucose.
- Drink in moderation. You’ll be more likely to make mindful food choices, consume fewer calories, get quality sleep, and feel better. For those who drink, the CDC defines moderate drinking as two drinks or less in a day for men and one drink or less in a day for women.
It’s also okay to forgo alcohol. Instead of an alcoholic beverage, why not try a low-sugar mocktail? You can swap in one of these alcohol-free alternatives for a regular cocktail, and their low sugar content will help with managing your glucose.
Here are two recipes you can try:
- Non-alcoholic mulled wine: This recipe makes five servings and contains around 13 g of carbohydrates per serving (which includes about 10 g of sugar).
- Ingredients:
- 1 bottle of alcohol-removed wine (or 2 cups of water and 2 cups of pomegranate juice)
- 1 orange, sliced
- 2-3 cinnamon sticks
- 2-3 star anise pods
- 3 cloves
- Fresh cranberries (optional)
- Cinnamon or nutmeg (optional)
- Instructions:
- If cooking on a stove: combine all the ingredients in a large pot and simmer for 25 min.
- If cooking with a slow cooker: combine all the ingredients and set the cooker to low for 2 hours.
- Ingredients:
- Cranberry spritzer mocktail: This recipe makes one serving and contains around 9.5 g of carbohydrates (which includes about 8 g sugar).
- Ingredients:
- 3 oz alcohol-removed sparkling white wine (not sparkling cider)
- 3 oz low-sugar cranberry juice
- 1-2 oz soda water
- Rosemary sprig and handful of cranberries, to garnish
- Instructions:
- Fill half of a white wine glass with ice.
- Pour in 3 oz of alcohol-removed sparkling white wine.
- Add 3 oz lower-sugar cranberry juice.
- Top with 1-2 oz soda water.
- Garnish with a sprig of rosemary and a few cranberries.
- Ingredients:
Findings from Research Studies
Findings regarding the role of dietary GI and GL in type 2 diabetes risk have been inconsistent. Some cohort studies have reported a positive association between GI and diabetes risk while others have not observed such association and some cohort studies have reported a positive association between GL and diabetes risk, whereas most have not.
A study examined the associations of dietary GI and GL and the associations of substitution of lower GI carbohydrates for higher GI carbohydrates with diabetes risk in a cohort of Finnish men. The cohort consisted of 25 943 male smokers aged 50-69 years. Diet was assessed, at baseline, using a validated diet history questionnaire. During a 12-year follow-up, 1 098 incident diabetes cases were identified from a national register. Cox proportional hazard modelling was used to estimate the risk for diabetes and multivariate nutrient density models to examine the effects of substitution of different carbohydrates.
Dietary GI and GL were not associated with diabetes risk; multivariate relative risk (RR) for highest versus lowest quintile for GI was 0.87 (95% CI: 0.71, 1.07) and for GL 0.88 (95% CI: 0.65, 1.17). Substitution of medium GI carbohydrates for high GI carbohydrates was inversely associated with diabetes risk (multivariate RR for highest versus lowest quintile 0.75, 95% CI: 0.59, 0.96), but substitution of low GI carbohydrates for medium or high GI carbohydrates was not associated with the risk. In conclusion, dietary GI and GL were not associated with diabetes risk and substitutions of lower GI carbohydrates for higher GI carbohydrates were not consistently associated with lower diabetes risk.
In this study, dietary GI was not associated with diabetes risk. Some cohort studies have reported a positive association between GI and diabetes risk while others have observed no such association. This finding of no association is in line with several studies that have included male subjects. Thus studies with men suggest that there is no association between dietary GI and diabetes risk. This contradicts findings from studies that have included only women and have suggested a direct association. This highlights the fact that dietary GI as an average measure of carbohydrate quality (calculated as a weighted mean of GIs of all foods consumed) may conceal many different dimensions of diet because the same dietary GI can be a result of several different combinations of carbohydrate-containing foods with different health effects.
The inconsistent findings between dietary GI and diabetes risk may partly be due to variability in essential carbohydrate sources in study populations. In this study, the main contributors of the interindividual variation in dietary GI, beer and milk, are examples of this, their consumption associated with diabetes risk contrary to expectations based on their glycaemic responses. Beer has a high GI value and consumption of beer was marginally inversely associated with the risk of diabetes. The inverse association is in accordance with former findings and may be due to lower insulin secretion influenced by alcohol consumption. Low GI food milk, instead, was positively associated with diabetes risk. Although milk produces a low glycaemic response, its insulin response is high.
In this study, dietary GL was not associated with diabetes risk. Many earlier cohort studies have not found an association between GL and type 2 diabetes, but a few have reported a positive association. GL, the product of GIs and grams of carbohydrates consumed, describe in addition to carbohydrate quality the amount of carbohydrates. Thus, GL can be altered either by changing GI or by changing the amount of carbohydrate consumed, or both. In using dietary GL to analyse disease risk, it is not possible to separate changes in carbohydrate quality and changes in carbohydrate quantity. In order for dietary GL to be a valid measure, reducing dietary GI should have the same metabolic effects as reducing the amount of carbohydrates in the diet. However, the effects do not seem to be the same.
The multivariate nutrient density model was applied to examine the associations of substitution of lower GI carbohydrates for higher GI carbohydrates with diabetes risk. This was done to better model the original aim of the GI concept to choose lower GI carbohydrates instead of higher GI carbohydrates when total carbohydrate intake is kept constant. The substitution of medium GI carbohydrates for high GI carbohydrates was inversely associated with diabetes risk. This finding is in line with the hypothesis that carbohydrates that induce a smaller elevation in blood glucose may have beneficial effects on diabetes risk compared with carbohydrates that induce higher blood glucose response. Contrary to the GI hypothesis, there was no decreased risk of diabetes when substituting low GI carbohydrates for medium or high GI carbohydrates. One explanation could be the major role of milk as a source of low GI carbohydrates. Recent prospective studies have suggested that consumption of low-fat dairy products is inversely associated with the risk of type 2 diabetes but their data are consistent with the possibility that milk seems to influence glucose tolerance more trough its insulinotropic effect than its relatively lower glycaemic load. However, a positive association between consumption of milk and risk of diabetes was found. This may be due to high consumption of high-fat milk since its saturated fat may have mitigated the potential benefits of other milk components.